Provider Demographics
NPI:1144435173
Name:BRANSCOMBE, RHONDA SUE (LPN)
Entity type:Individual
Prefix:
First Name:RHONDA
Middle Name:SUE
Last Name:BRANSCOMBE
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:47 WALNUT ST
Mailing Address - Street 2:
Mailing Address - City:SHELBY
Mailing Address - State:OH
Mailing Address - Zip Code:44875-1534
Mailing Address - Country:US
Mailing Address - Phone:419-347-1448
Mailing Address - Fax:
Practice Address - Street 1:47 WALNUT ST
Practice Address - Street 2:
Practice Address - City:SHELBY
Practice Address - State:OH
Practice Address - Zip Code:44875-1534
Practice Address - Country:US
Practice Address - Phone:419-347-1448
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-12
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN 115677164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2526583Medicaid